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Every positive stool test in England, from the screening programme and from the symptomatic pathway, ends in a colonoscopy. The thresholds have been lowered faster than the capacity to act on them, and who performs the test decides whether it prevents anything.
This is a placeholder for the UK-specific analysis written by the UK and NHS file of this deep dive, which owns the programme ages, the symptomatic faecal immunochemical test threshold in NICE NG12, the National Bowel Cancer Audit indicators and the endoscopy workforce figures. The evidence this roadmap can contribute is the general form of the constraint: NordICC showed that a screening programme delivers the effect of its uptake, not of its test, and Kaminski showed a roughly tenfold difference in interval cancer risk between endoscopists with adenoma detection rates below 11 percent and above 20 percent.
The two levers are therefore capacity, which sets how quickly a positive test reaches a colonoscopy, and quality assurance, which sets whether that colonoscopy finds the adenoma. Neither is a research question in the usual sense, which is why they attract less attention than the trials on the rest of this page.
A colonoscopy probably does reduce bowel cancer risk for the person who has it, but a programme that offers colonoscopy achieves much less if most people decline. Programmes based on stool tests with high uptake may deliver as much population benefit at lower cost and risk.
Durability is what makes endoscopic screening cost-effective: one procedure at 55 buys nearly two decades of protection, which is the argument for long intervals rather than frequent tests.
The paper that made the adenoma detection rate the central quality measure of every screening endoscopy service, and the reason endoscopist-level auditing is a condition of accreditation.
Shares AI polyp detection in colonoscopy, Quality indicators for colonoscopy and the risk of interval cancer, NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Faecal immunochemical test (FIT) and the tag colorectal-evidence.
Shares Quality indicators for colonoscopy and the risk of interval cancer, NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Colonoscopy, Endoscopy (EGD, EUS, ERCP) and the tag colorectal-evidence.
Shares Long term effects of once-only flexible sigmoidoscopy screening after 17 years of follow-up, Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Cancer Research UK and the tag colorectal-evidence.
Shares Faecal immunochemical test (FIT), Colonoscopy, National Institute for Health and Care Excellence, Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood) and the tag colorectal-evidence.
Shares Faecal immunochemical test (FIT), Endoscopy (EGD, EUS, ERCP), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation and the tag colorectal-evidence.
Shares Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, The hardest cancers are found late and the tag colorectal-evidence.
Shares NordICC: inviting people to a screening colonoscopy reduced bowel cancer, but less than expected, Faecal immunochemical test (FIT), Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), The hardest cancers are found late and the tag colorectal-evidence.
Shares Colorectal cancer screening (colonoscopy, FIT, stool DNA, blood), Colorectal cancer roadmap: from the adenoma-carcinoma sequence and the first screening trials to total mesorectal excision, oxaliplatin, RAS testing, immunotherapy for mismatch repair-deficient disease, ctDNA-guided treatment and organ preservation, The hardest cancers are found late, Most of the world has almost no cancer care and the tag colorectal-evidence.